Healthcare Provider Details

I. General information

NPI: 1083759062
Provider Name (Legal Business Name): SP EMR MED ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 11/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7909 HIGHWAY N
DARDENNE PRAIRIE MO
63368-7382
US

IV. Provider business mailing address

1801 SPRINGDALE ACRES LN
SAINT LOUIS MO
63131-3627
US

V. Phone/Fax

Practice location:
  • Phone: 636-625-1650
  • Fax: 636-625-1395
Mailing address:
  • Phone: 636-625-1650
  • Fax: 636-625-1395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberR6D97
License Number StateMO

VIII. Authorized Official

Name: SHIRIN PINTO
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 636-625-1560